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Lance Fletcher and his dad fought a war on two fronts. Now that their family is reunited and Lance’s osteosarcoma is in remission, the Fletchers concentrate on constructing a future.

When Joe Fletcher left home to serve his country in Afghanistan, he knew all too well that he would be living in a dangerous environment far from his wife, Carol, and his children, Lindsey and Lance. But never in his wildest dreams did Joe envision that his son would soon be waging his own private war.

After having served 18 years in the Army National Guard, the longtime school teacher had been unsurprised when his third deployment order arrived. This time, he would command a mentoring team that would provide training to the Afghan National Police.

Situated on a flat plain surrounded by craggy peaks, the terrain of Mazir-e-Sharif, Afghanistan, reminded Joe of the American West. But the comparisons ended there. Clad in 60 pounds of body armor, Joe traversed an alien landscape of unfamiliar customs, language and culture; a place where deadly explosive devices could lurk just beneath the dust and where many citizens lived in mud huts with dirt floors. When an explosion killed two members of another team in July of 2008, Joe pondered:

“I’ve always believed that the choices you make in life determine what happens in your future. At times though, I have to admit that there are times when life takes a detour that is beyond your control. Tragedy often strikes when we least expect it, whether it’s a fatal accident two blocks from home or a chronic disease.”

Ironically, more than 7,600 miles away, stealthy cancer cells were multiplying in the leg of Joe’s 8-year-old son.

Trouble on the home front

At home in New Mexico, Lance was making the most of his summer vacation. He tossed balls with his cousins, attended church camp and played outside with his best friend, David. Occasionally, Lance mentioned an ache in his leg. Carol chalked it up to growing pains. After taking a mild pain reliever, Lance would drift off to sleep, dreaming of more summertime adventures.

The night before the family left for a trip to Pennsylvania, Carol noticed a swelling in Lance’s left leg. She applied ice to the area and limited her son’s activities for several days. “He’s wrenched his knee or stretched some ligaments,” Carol thought, and made a mental note to visit the pediatrician upon their return home.

Most parents have never heard of the bone cancer called osteosarcoma, but the Fletchers were all too familiar with the disease. Long ago, Joe’s 27-year-old sister had died of that kind of cancer, after receiving what Joe believed to be less-than-optimal care at a regional hospital.

Only a few hours after Lance’s X-ray, doctors confirmed that he did, indeed, have osteosarcoma.

When the physician asked Carol where she would like to take her son for treatment, she named a medical facility in the region. “I chose that hospital because it was only two hours away from our home. But I wasn’t at peace about my decision,” Carol recalls.

Divided by miles, united in spirit

In Mazir-e-Sharif, Joe checked his e-mail and found a cryptic message from his wife. “Give me a call no matter what time it is,” she wrote.

“I immediately knew something was wrong,” he says.

As Joe talked with Carol, images of his sister and his beloved son rolled through his mind like tanks on a battlefield. “When you go to Afghanistan, you’re mentally prepared that you may come back hurt or harmed,” he says. “But you never expect something life threatening to happen to one of your kids. It’s a devastating feeling.”

Because of his sister’s experience, Joe knew the importance of beginning treatment as quickly as possible. Like Carol, he was uncomfortable obtaining treatment at the local hospital. “I want the best for Lance,” he said. The couple immediately began researching osteosarcoma treatments online and through conversations with friends.

Carol first learned about St. Jude Children’s Research Hospital through her aunt. The mother of one of Lance’s classmates also told Carol about the hospital’s new osteosarcoma study. But before the Fletchers could make a final decision, Carol knew she needed some quiet time.

“That weekend, I spent a lot of time in prayer,” she says. “I asked for a bit of guidance and for the right doors to be opened.”

The first thing Monday morning, Carol called the pediatrician’s office and asked if Lance could obtain a referral to St. Jude. “I prayed, ‘Lord, if this is not it, please close that door,’” Carol recalls. “And every door opened; everything went through. It was amazing.”

The next morning, she and Lance were on a plane to Memphis, Tennessee.

When the duo walked through the doors of the St. Jude Patient Care Center, Carol breathed a sigh of relief. “Oh, we’re gonna be OK,” she thought. “Things are gonna be fine.”

The best medicine

When Lance arrived at St. Jude, doctors immediately noticed a small spot on his lung. Sometimes lung scans show spots that indicate harmless scar tissue from past infections. But the physicians wanted to check out this spot. “Carol and I discussed whether we should let them biopsy Lance’s lung, because it was probably nothing,” Joe recalls. Today, the Fletchers are relieved that they agreed to the biopsy. The cancer had, indeed, spread to that area. After the cancerous tissue was removed, Lance began treatment on a new protocol, or scientific treatment plan, led by St. Jude oncologist Najat Daw, MD.

“The outcome of patients with osteosarcoma has reached a plateau, and we need a novel strategy to improve it,” Daw says. “We hope the new trial will help us increase survival rates for children with this disease.”

The protocol combines standard chemotherapy with therapy designed to target the tumor’s blood vessels and enhance the tumor-killing ability of the chemotherapy. Clinicians are studying whether a monoclonal antibody called bevacizumab inhibits a protein that stimulates blood vessel formation in osteosarcoma tumors. Bevacizumab has already been used in adult patients with cancer to improve the efficacy of standard chemotherapy.

As part of his treatment, Lance also underwent a limb-sparing operation, in which part of his diseased femur was replaced with a prosthesis that can be extended as he grows. When the time comes to lengthen the bone, a donut-shaped coil emitting an electromagnetic field will be placed around Lance’s leg. The magnetic field heats a plastic tube within the prosthesis. As part of the tube melts, an internal spring uncoils and the prosthesis lengthens. When Lance reaches his full height, surgeons will replace this prosthesis with an extremely strong permanent prosthesis.

“If we had stayed in our area and gone to one of the hospitals in the region, the odds that Lance would have kept his leg are pretty slim,” Carol observes. “They would have probably done an amputation, because that’s the easiest thing for them to do.”

“Lance initially had some trouble with the chemo,” recalls Kerri Nottage, MD, an Oncology fellow. “I would walk into his exam room and he would just be lying on the table. Then one day, I walked into his room and he was sitting up. I was shocked and thrilled. It was nice to walk in and get that surprise. Now, when I walk in, he is usually playing. That’s great to see.”

Nottage has also been an enthusiastic victim of Lance’s practical jokes. One memorable prank involved a whoopy cushion he placed below the paper on the examination table. When she asked him to roll over during the exam, the cushion made its noise. Nottage played along. “I thought it was hysterical,” she says.

Friends through the seasons

Although the chemotherapy treatments have been brutal, Lance has coped with the help of his close-knit family, his friends and his increasingly varied interests. “He’s very, very smart, and he’s a self-motivated learner,” observes Michaela Shurden, Lance’s third-grade teacher in the St. Jude School Program.

“I like to draw landscapes; I like to build. I think I’m going to go to school to be an engineer,” Lance recently announced.

Shurden encourages Lance in his aspirations. “He’s extremely good at math, and he has begun constructing electrical circuits using a kit we have in the classroom,” she says. “He could be an engineer for sure.”

Child Life Specialist Jessika Morris also has a special bond with Lance. “He’s a deep thinker,” she says, noting that the 9-year-old is creative and perceptive, upbeat and cheerful. She is helping Lance create a book that chronicles his experiences at the hospital. “The project is completely led by Lance,” Morris explains. Lance has photographed hospital places and people who are important to his story and has divided the book into seasons. “Since he has been here for nearly a year, he wanted to use ‘the seasons of St. Jude’ as a theme,” Morris says. “When he returns home, he can use the book to help his family and friends understand his journey.”

One of Lance’s chief interests recently has been the small, knobbed building blocks called Legos.

“He’s a regular Lego maniac,” says Joe, as his son climbs into his lap.

“I built a Republic gun ship from Star Wars that had 1,043 pieces,” Lance explains.

Lego instructions encourage users to separate the Legos by colors before beginning construction. But the budding engineer scoffs at the thought. “I don’t do that,” he says. “I like a challenge.”

Carol and Joe bought a tripod and camera so that their son can make stop-motion animation films with his Lego creations. Lance takes a photo of a character or vehicle, moves the item slightly and takes another photo. It’s a meticulous and time-consuming process. When the hundreds of photos are eventually assembled, the characters seem to move. “I’ve got one of my movies on YouTube,” he explains. “It’s a light saber duel.”

Now that his dad is home, Lance is building more than Lego creations. He and his family are constructing a future. They can see it now, just ahead. And incoming patients at St. Jude can glimpse the excitement shining in the faces of the Fletcher family. Joe summed it up in a May 2009 entry to his online journal:

“There are always new children arriving at St. Jude for treatment. The new ones are usually easy to spot because they’re the ones that still have their hair. I feel a little tug in my heart when I see them because I remember when we first arrived. I remember that feeling of despair of not knowing what will happen to your child. St. Jude helped us get through that time, and everything is going well.

I smile once again as I think about Lance being down to his last three chemo treatments. We’ve come a long way. I’m enjoying each and every day with my little man and looking forward to the day when we go home and live together as a family.”